Takayasu arteritis (pulseless disease) is a granulomatous large-vessel vasculitis predominantly affecting the aorta and its major branches in young Asian women. The CD8+ T-cell mediated destruction of medial smooth muscle cells and elastic lamina leads to which pathological outcome that explains absent radial pulse?

• A Fibrous intimal hyperplasia and thrombotic occlusion causing stenosis ✓
• B Aneurysm formation due to medial weakening
• C Calcification of the adventitia causing rigidity
• D Periarterial lymphadenitis compressing the vessel lumen

Explanation

In Takayasu arteritis, the granulomatous inflammation destroys the media, and the repair response produces marked fibrous intimal hyperplasia and adventitial fibrosis — creating stenotic lesions that reduce blood flow and cause absent pulses (hence 'pulseless disease'). While aneurysmal dilation can occur (particularly at the aortic arch), the more common outcome is stenosis/occlusion of the subclavian, innominate, and carotid arteries. The natural history: early active phase (systemic inflammation, elevated ESR/CRP) → burnt-out fibrotic phase (fixed stenoses). Differential: Giant cell arteritis (older women, temporal artery, jaw claudication, visual loss).

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.